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[JuliaDS]

Hello all!

I'm so happy to have found this site! I had my RNY in MA in 2007 and never lost more than 100lbs. I've been living on less than 30 carbs a day and exercise as much as I can at my weight. I've had full work ups in every area and all consensus is that RNY wasn't the right surgery for me. I desperately want to revise to DS. The surgeon I've been having all my follow up with suggested SIPS but I'm set on DS so I came here to find surgeon suggestions. I found some great names that you've all suggested and I'm planning on choosing one soon. Hoping to connect with others who have revised from RNY to DS and who have traveled within the US to do their surgery.

Hope to chat soon!

Hi and welcome! I'm a virgin DS so can't help with your specific situation but wishing you luck with your decision. Lots of good advise here so read all you can and ask questions. Looking forward to following your journey!

 

[DSRIGGS]

Thank you!!! I've heard of it, I think. Does it relate to tailoring the lengths to the patient instead of one size fits all? If you have time to elaborate then that's great but if not then I'll certainly research it!

Yes it is all about tailoring CC, AL & BPL Lengths to the patient as 10%/40%/50% respective proportions of total small bowel length.

Basically a smart man, Douglas Hess determined that if the absorbing path (AL + CC) to non absorbing path (BPL) was 50/50 that was the sweet spot for optimum health and weight loss. There is a trade off. When you lose too much weight to reach barbie doll looks with bariatric surgery chances are you won't be healthy. For example I am a 22.5sh BMI and I am not very healthy. I am desperately trying to get my weight up about 15-20 pounds and BMI around a 25.

I am a prime example of the standard limb length DS failing the patient terribly. My original DS surgeon gave all his patients 100 cm CC & 150 cm AL lengths with total disregard to total small bowel length (SBL). So my total SBL was 725cm so 100/725 = 13.8%, 150/725 = 20.7% so I had only 34.5% of my intestine length as absorbing intestine and became severely malnourished and spent a week in the hosopital as I was passing out, HR of 35 and BP of 70/40......I eventually had to be revised to lengthen my AL. Put another way, my CC + AL should have equaled 362.5 CM or 11.89 feet and it was only 8.2 feet so I was only a little less than 4 feet short on my absorbing path.

Bottom line is that you don't want to short of an absorbing path or you will end up malnourished or too long of an absorbing path as there is a good chance you won't lose all the weight you want.

 

[southernlady]

I am a prime example of the standard limb length DS failing the patient terribly. My original DS surgeon gave all his patients 100 cm CC & 150 cm AL lengths with total disregard to total small bowel length (SBL).

And then on the other side of that bell curve are people who did just fine.

I do believe in the Hess method but mine is what it is and it has done well for me.

 

[DSRIGGS]

And then on the other side of that bell curve are people who did just fine.

I do believe in the Hess method but mine is what it is and it has done well for me.

It is my opinion that the standard limb length DS works for those whose small bowl length matches up with those standard limb lengths used by the surgeon,. and that doesn't mean that the CC has to be exactlty 10% and the AL exactly 40%, but the combination of the two equals roughly 50% of total SBL (+ or - 5% or so). That combination of AL + CC length = 50% of total SBL and each component length not being exactly 10% and 40%:respectively is what I was told is Dr Gary Antone's working hypothesis. I believe he gives people a slightly longer CC than 10% and AL shorter than 40% in many people but he gets to that 50% combination.

Liz, do you know your AL length? I have a gut feel that your CC + AL length is roughly 50% of your total SB length even though you have a longer than typical CC.

As I have stated many times, the Standard Limb length DS works for many, but those of us who have a total SBL that is either longer or shorter than the length that would yield that 50/50 + or - 5% ratio, end up losing too much or not enough weight.

In that regard I would say that many people (you being one) fit under the bell curve of the normal distribution for total SBL and consequently have working DS's while the tail ends of that curve is made up of those of us with either significantly longer or shorter than normal total SBL. What the mean SBL value is I do not know, nor do I know what that variation +/- total SBL length is that would put somebody on the non working tails of that curve.

 

[southernlady]

Liz, do you know your AL length? I have a gut feel that your CC + AL length is roughly 50% of your total SB length even though you have a longer than typical CC.

No, I don't right off hand and not sure it's listed in my op report which I do have. But you may be right.

 

[DSRIGGS]

No, I don't right off hand and not sure it's listed in my op report which I do have. But you may be right.

I think the Anthone theory makes a lot sense, and even Hess didn't do exact 10%/40% channels. He and Dr K round up to the next 25cm increment for cc and 10cm for AL and they set the common channel pretty much an let the AL fall where it falls to hit the 50/50 ratio.

For example for somebody with an 800cm SBL the exact 10% and 40% lengths would be 80 and 320, but Hess and Dr K would make it 100 and 300.

It is an interesting discussion to me.